Article Figures & Data
Figures
- Figure 1.
Example of a Quit Line referral report.
- Figure 2.
Clinician referrals to Quit Line by quarter.
Mantel-Haenszel χ2: P <.001.
- Figure 3.
Participant disposition and summary outcomes.
Tables
Characteristic Total No. Interventin No. Control No. PValue * χ2 test. † t test. Recruited, No. 87 43 44 Location, No. .69* Southeast Michigan 16 9 7 Mid-Michigan 23 10 13 Southwest Michigan 17 10 7 Northern Michigan 31 14 17 Size of community, No. .83* <5,000 10 6 4 5,000–10,000 7 3 4 10,000–25,000 26 12 14 25,000–100,000 23 10 13 >100,000 21 12 9 Proximity to major city, No. .76* Not within 25 miles 29 15 14 Within 25 miles 58 28 30 Practice type, No. .72* Solo 13 6 7 2-person 16 6 10 Group practice 37 20 17 Multispecialty group practice 21 11 10 Patients aged >65 years, mean % (SD) 24.7 (17.8) 21.0 (15.4) .34† Patients white, non-Hispanic, mean % (SD) 78.0 (23.6) 82.2 (19.0) .38† Patients uninsured / Medicaid, mean % (SD) 19.5 (18.4) 23.3 (20.2) .40† Estimated smoker visits per quarter, total No. 22,163 23,537 Characteristic Total No. Intervention No. Control No. PValue * χ2 test. † Fisher’s exact test. Recruited 308 163 145 Sex .69* Male 163 88 75 Female 145 75 70 Clinician type .95* Physician 234 124 110 Nurse-practitioner 31 17 14 Physician’s assistant 43 22 21 Specialty .45* Family medicine 171 85 86 Internal medicine 88 50 38 Obstetrics-gynecology 49 28 21 Smoking status .45† Current 3 2 1 Past 48 29 19 Never 254 129 125 Enrollment Status Usual Quit Rate (%) Intervention (n = 484) Control (n = 220) * Actual referrals x estimated quit rate = number of quits. Level 1, enrolled in Quit Line 25 73 × 0.25 = 18.25 72 × 0.25 = 18.00 Level 2, brochure and callbacks 15 126 × 0.15 = 18.90 62 × 0.15 = 9.30 No enrollment, clinician advice only 10 285 × 0.10 = 28.50 86 × 0.10 = 8.60 Total estimated quits 65.65 35.90 Outcome Total $ Intervention $ Control $ QTN = telephone Quit Line service. Total cost per outcome Cost per referral 33.89 38.60 23.60 Cost per QTN enrollee 71.65 93.68 38.92 Cost per quit 235.88 285.72 145.28 Incremental cost per outcome Cost per referral 21.69 23.51 17.70 Cost per QTN enrollee 45.85 57.07 29.18 Cost per quit 150.93 174.04 108.93
Supplemental Appendix
Supplemental Appendix. An Intraclass Correlation Model for a Physician-Based Sampling Scheme.
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 2 pages, 94KB
The Article in Brief
William C. Wadland, MD, MS, and colleagues
Background This study compares two methods of encouraging doctors to refer patients who smoke to a telephone quit line. The methods are comparative feedback (doctors receive information comparing their rates of referring patients to the quit line with those of other doctors, particularly with other doctors who refer at high rates) and postcards reminding them about quit line services. The quit line is a 24-hour service staffed by trained nurses who counsel callers in how to quit smoking and keep from starting again.
What This Study Found Doctors who receive comparative feedback refer patients to a smoking quit line at higher rates than doctors who receive a postcard reminder. The estimated number of referred smokers who quit was 66 in the feedback group and 36 in the postcard reminder group. The added cost to develop feedback information was about $65 per estimated patient who quits smoking.
Implications
- Comparative feedback on referrals to a smoking quit line had a modest effect on doctors.
- The additional cost of providing feedback information is small considering the effectiveness of the feedback method and the long-term health benefits of stopping smoking.
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